Q: What factors need to be considered with an acute spinal cord injury (SCI)?

A: For acute spinal cord trauma, stabilization is the first priority. After an injury, according to Jack de la Torre MD PhD, there are biochemical, metabolic and physiological issues that arise such as reduced blood flow to the spinal column, the formation of free radicals, sodium channel activation, inflammation and energy substrate depletion.

To address these issues de la Torre suggests the use of fructose 1,6-diphosphate combined with dimethyl sulfoxide (DMSO) as when combined, the two stabilize the SCI and provide a high-energy substrate to the damaged tissue. Dr. de la Torre is a professor of neurosurgery and physiology at the University of New Mexico Medical School in Albuquerque who has been one of the main advocates for the use of DMSO, a controversial drug that has many healing properties.

Anders Holtz with the Department of Neurosurgery, University Hospital in Uppsala, Sweden emphasizes the need to consider secondary injuries that can result from surgery. He believes that the aim of surgery is to minimize neurological deterioration, stabilize and align the spinal cord, reduce pain and prevent secondary complications.

Immediately after a trauma to the spine, Holtz stresses the importance of monitoring the respiration system in order to time drug treatment so that the chosen medication is given at the most optimal time. In addition to the respiratory system playing an important role in medication administration, it also accounts for a high percentage of illnesses in SCI patients.

According to the Journal of Neuroscience Nursing in an article by Kathleen T. Lucke, “lung diseases and breathing complications cause significant illness in patients following spinal cord injuries. The mortality rate from pulmonary complications, such as pneumonia, lung collapse, respiratory failure, and infections, can be 40-80% in the first year after injury.”

As you can see, there are a variety of important factors that need to be addressed and closely monitored immediately and soon after a SCI. Awareness of the areas of special concern will help you to better understand what your doctor is focused on and why - not to mention that this knowledge will help you to determine if your doctor is competently approaching the treatment of the injury.

The majority of people who sustain SCIs will not have the medical knowledge to determine the best course of treatment, but even some awareness of the problems that can arise can add to you overall security that you are getting the best treatment available.

For further reading:
Essentials of Physical Medicine and Rehabilitation, Review and Self-assessment, Julie K. Silver & Walter R. Frontera, pp. 346, 2003. Price £28.99. ISBN: 1-56053-563-6. Hanley & Belfus, Philadelphia

Pulmonary management following acute SCI. (spinal cord injury) Journal of Neuroscience Nursing; Apr 1, 1998; Lucke, Kathleen T.

Q: Is there any recent research that supports the idea of brain plasticity?

A: There have been a handful of studies over the last decade that can be considered to support the idea of brain plasticity, the brain’s ability reorganize in response to input, a very useful growth mechanism that can benefit traumatic brain injury (TBI) recovery. Here is one of the most recent areas of research:

A study from the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center (BIDMC) has shown through tests on the effects of blindness that the brain possesses more reorganization ability than originally assumed.

How does vision and brain plasticity mesh? The studies’ senior author Alvaro Pascual-Leone, the director of the Berenson-Allen Center, used blindfolded subjects to demonstrate how the area of the brain that controls vision quickly switches to touch when the use of the eyes are no longer available.

Pascual-Leone believes that this indicates an ability that was dormant while sight was intact. It’s not that our brain is creating new connections, according to the author, but that they already exist. In this study, the blindfolded participants were better at learning Braille than those without.

According to the Newswise article, “as predicted, the researchers found that the subjects who were blindfolded were superior at learning Braille than their non-blindfolded counterparts. Furthermore, the brain scans of the blindfolded subjects showed that the brain’s visual cortex had become extremely active in response to touch (in contrast to the initial scan in which there was little or no activity).”

We can all most likely recall times that we closed our eyes to better hear or taste something, and because of these automatic impulses, we have already experienced the brain’s ability to compensate with the other senses. Studies like this one bring our brain’s amazing potential into relief.

Those with brain injuries experience everything from a slightly impaired ability to recall things to a loss of all conscious awareness. It will be interesting to see how these discoveries can be applied to TBI patients and whether or not there is the potential to stimulate non responsive areas of the brain with these methods.

Q: What spinal cord injuries occur most in sports?

A: There are two types of spinal cord related injuries that occur most frequently in sports. The first is called a stinger or burner and the second is transient quadreplegia. While they can happen in almost any sport, they are most commonly found in contact activities such as wresting, rugby and football.

Stingers are a painful nerve injury created by compression in the neck or shoulder area that creates a sharp stinging or burning sensation in an arm. Transient quadriplegia typically results from hyperextension of the neck coupled with cervical spinal stenosis or disc protrusion.

The aptly named stingers affect close to 50 percent of those in contact sports, while the more debilitating transient quadriplegia occurs in roughly 1.3 athletes out of 10,000. Overall, spinal cord injuries are decreasing as better equipment is created and worn.

Q: What are the most common results of a spinal cord injury?

A: Depending on the particular injury sustained, there are a wide variety of primary and secondary complications that can result from a spinal cord injury.

Damage to the nerve fibers that carry motor signals to the brain through severing or compression can lead to muscle paralysis and loss of sensations such as those experienced through touch or pressure. Other potential effects are loss of bladder control, muscle contractions, decreased breathing capacity, exaggerated reflexes, over or under sensitivity to temperature changes, lasting pain, impaired sexual functioning and issues with bowel control.

Some of the most common secondary effects are increased blood pressure, sweating, pressure sores and an increased susceptibility to respiratory ailments.

Typically any of these functions that are lost will be regained within six months, if they are to return at all. After that point your chances of recuperation decreases greatly. This is why it is so important to make sure you receive proper care immediately after sustaining a spinal cord injury.

Q: What was the inspiration for the Paralympics?

A: Originally the Paralympics were created as a rehabilitation program for British war veterans who had spinal injuries. In 1948 Sir Ludwig Guttman, a neurologist at Stoke Mandeville Hospital in Aylesbury, added sports to help his patients rehabilitate.

He set it up as a competition between his hospital and others, and held it during the London Olympics. This idea was adopted by hospital after hospital throughout Britain and in 1960, Guttman brought 400 of these athletes to Rome to compete during that year’s Olympics. It was then that the name “Paralympics” was coined.

By 1968 there were more than 1,000 athletes participating from 44 countries. Today the Paralympics host elite athletes from six different disability groups. Since the beginning, they have been held in the same year as the Olympics, and often in the same city. This year they will be held in Beijing, China and the Winter Paralympics for 2012 will be in Vancouver, Canada.

Q: Since my spinal cord injury, I have been living with chronic pain and my doctors have been unable to figure out what’s causing it. Why is it so hard to pinpoint?

A: Chronic pain is often difficult to find one specific cause for due to a combination of factors. First, patients who suffer from chronic pain, no matter what the initial injury was, often also experience anxiety and depression. These two strong emotions not only interfere with a proper diagnosis, but contribute to the pain.

One theory is that an injury causes increased nervous activity that transmits pain from the spinal cord to the brain, damaging the nerve circuits it passes through. These circuits amplify the pain beyond what the physical injury would seem to suggest.

The idea being considered by researchers is that these “pain amplifying circuits” have become self-sustaining. If this is the case, the next step is to figure out if they can be turned off or at least dialed down. We don’t have the answers yet, but at least there is some comfort in the knowledge that scientists are working on a solution.

Q: Since my brain injury, I have memory loss and difficulty concentrating. Is there anything I can do to improve this?

A: There was a time when doctors assumed that the brain, once damaged, couldn’t regain any of it’s previous functions, but thankfully we have progressed beyond that limited evaluation.

We now know that there are things we can do to improve brain functioning after a traumatic brain injury (TBI). In addition to the rehabilitation that the doctor will recommend after an injury, there are a variety of exercises that you can do on your own that will help to boost brain power.

Some researchers claim that music incites increased brain function by creating connections between the right and left brain hemisphere. The interplay that allows you to learn music utilizes both your creativity and your reasoning, strengthening cognitive capacities and developing better organization skills. By learning a new musical skill, you potentially improve your mind’s flexibility.

Others stress the importance of physical exercise, especially aerobic activities. While this area still needs more study in order to clarify what specific processes are happening to cause improved memory and general mental function, there have been a handful of seemingly conclusive tests creating a definite link between the two. Some speculate that it’s the increased blood flow bringing oxygen to the brain that promotes these beneficial effects. This doesn’t mean that you need to run for hours a day. Find an activity that you enjoy, be it running or biking, hiking or swimming, and try to increase the time spent doing it.

Besides learning a new musical skill or upping your aerobic activity, you can also practice brain exercises that will help you to increase your capacity to process information with speed and efficiency. There are a wide assortment of books and Websites that not only detail different activities, but walk you through them. Here are a few to get you started:

COM

Workbook for Cognitive Skills

The Brain Injury Workbook

Whichever steps you decide to take to improve and even regain your cognitive capabilities, keep in mind that scientists are just starting to discover the brain’s recuperative abilities. Don’t give up hope!

Q: What can you do immediately after an accident to minimize the long-term effects from a spinal cord injury (SCI)?

A: While there is still no way to completely reverse the damage done by a SCI, there are certain steps you can take to prevent further damage and to minimize the long-term effects.

After someone is discharged from the treatment facility, medical staff will focus on treating the initial injury, making sure it doesn’t develop into a worsening condition. Medications, immobilization and surgery will address the initial issues that arise from the accident, be it paraplegia or quadriplegia.

Once the patient is on his or her own, it becomes important to focus on the issues that can develop from being immobilized. Muscles will need to be stretched and maintained, bedsores watched for and treated and the urinary tract will have to be closely monitored to prevent infections. Paying attention to these aspects of care early on will help to prevent them from creating irreversible damage.

Rehabilitation therapy will be structured around the particular injuries each patient has suffered, and will attempt to help with the family and patient’s adjustment to their new situation. Sticking with the suggested program, exercises and all, is very important to the patient’s overall chance of recovery and regaining any degree of functioning.

During the difficult period after an injury is sustained, it is typically hard for people to maintain a positive and gung-ho attitude, but that the best chance to regain the ability to participate actively in life is to dive right into their rehabilitation program can’t be stressed enough.

Q: Where can I find clothing and accessories that work with my disability?

A: There are a multitude of resources for “adaptive” clothes and home health products. Whether you are trying to obtain weather proofing for wheelchair outings or you need affordable Velcro mittens, there is a place that can provide what you need. Here are some good resources:

AbleApparel

Adaptations by Adrian

Adaptive Clothing Showroom

Clothing Solutions

Easy Access Clothing

Epiphany Design

Housecalls Network

Janska

MJ Designs, Inc.

Professional Fit Clothing

If you have a personal favorite, please share!

Q: What should you look for when considering a SCI Rehabilitation Program?

A: There are a wide variety of rehabilitation programs, so finding the right one for your situation requires a comparison of your specific needs and what the center can offer you. Here are some useful questions to ask during your search:

Are the beds for people with SCI in the same area of the facility? Are there people in the SCI program of the same age and sex as the person considering admission?

Do the people in the SCI program have similar levels and kinds of spinal cord injury e.g., quadriplegia, paraplegia, incomplete and complete?

What is the average number of people admitted annually to the SCI program? (program staff should treat people with SCI on a regular basis to acquire and maintain expertise.)

Is the SCI program accredited by the Commission on the Accreditation of Rehabilitation Facilities (CARF) or theJoint Commission on Accreditation of Healthcare Organizations (JCAHO)? Has it been designated as a Model Spinal Cord Injury Center by the National

Institute of Disability Research and Rehabilitation (NIDRR)? Click here for a current list of Model spinal cord injury centers)
Is the SCI program part of a SCI rehabilitation system operated by the state?

Are there treatment specialists in the SCI program who speak the primary language of the individual seeking treatment?

Will the treatment team develop a rehabilitation plan with both short and long term goals?

Will an experienced case manager be assigned to help family members obtain medical payments and other benefits from public and private insurance? Will a team member be assigned to coordinate treatment and act as a contact for staff and family members?

Staffing/Rehabilitation Program Elements

Is the physician in charge a Physiatrist? If not, what credentials does he/she have? How long has the physician in charge been directing programs specializing in SCI? Is there physician coverage seven days a week? Twenty-four hours a day?

Do the regular nursing staff and other specialists responsible for providing treatment in the SCI program have specific training in treating SCI? Is the nursing staff employed by the hospital or employed through an outside agency?

Does the program ensure the availability of rehabilitation nursing and respiratory care on a twenty-four hour basis?

Are there consultants available at the facility or nearby medical centers? These should include neurosurgery, neurology, urology, orthopedics, plastic surgery, neuropsychology, internal medicine, gynecology, speech pathology, pulmonary medicine, general surgery and psychiatry.

How often and for how long each day will participants get treatment by specialists such as occupational and physical therapists? Treatment should be no less then three hours per day.

Are other specialties such as driver education, rehabilitation engineering, chaplaincy, and therapeutic recreation available if needed?

Are activities planned for SCI program participants on weekends and evenings?

How much time is spent teaching SCI program participants and their families about sexuality, bowel and bladder care, skin care and other essential self-care activities?

Does the SCI program offer training in the management and hiring of personal care assistants? If so, how much time is spent by staff on this topic?

Questions have been taken from Spinal Cord Injury Resource Center, a site created and maintained by a SCI patient who has drawn the previous questions from his own experience.